HUMANIMAL
Cataracts
By Joy Pape, FNP-C, CDCES, Jonathan Kruh, MD, and Nicole Cerniello, DVM
Since many eye conditions occur in both humans and animals, I reached out to Dr. Jonathan Kruh, ophthalmologist, and Dr. Cerniello, veterinarian, to tell us about cataracts.
Humans
By Dr. Jonathan Kruh
A “simple” cataract is the leading cause of preventable blindness in the world. That may seem surprising given that cataract surgery is so commonplace. Yet, an alarming number of people in the United States still go blind due to cataracts. There are many reasons that people choose to forgo cataract surgery, such as fear, ignorance, complacency, lack of health insurance, and age. Although each person often has their own unique reason to move forward or to wait, cataract surgery is a conversation of great discussion amongst older groups of people. It is truly water cooler talk once you hit 60-65.
A cataract is a clouding or browning of the natural crystalline lens inside of the eye. The crystalline lens is what focuses light directly onto the retina allowing us to see an image. If the lens is not clear, the image will become out of focus or blurry. Once the lens has turned cloudy or opaque it is deemed a cataract.
As we get older, there are many natural changes that occur throughout the human body, and the development of cataractous changes is ubiquitous. As these changes occur, they can often come with debilitating and life altering compromises due to visual impairment. The most common signs of a cataract are glare, halos, and difficulty with contrast and low light settings. In the eyes of a person looking through a cataract (browned or opaque lens), often the appearance of colors can be distorted and the world is viewed in sepia. Surprisingly, since cataracts can take many years to mature, the average person often does not realize how much cataracts are affecting their vision until post-surgery. Patients often remark that “my apartment was not as clean as I thought!” and “the colors of my apartment walls are now different.” It truly can be eye-opening to see colors again and vision with clarity often described as “high-definition,” that one has not had since their early childhood.
Fortunately, we have entered the golden age for cataract surgery. The surgical procedure entails replacing the natural crystalline lens with an intraocular lens implant. In the hands of a seasoned surgeon the procedure often takes about 10 minutes and is painless! Furthermore, there are often no stitches since the incisions are so minute they are self-sealing. In addition, there are now a wide array of specialty implants to choose from that can correct not only one’s distance vision, but intermediate and near vision as well. Some of the options are monofocal, toric, extended depth of focus, multifocal, and light adjustable lens. There are so many options it can actually be daunting for a patient to choose the lens implant that is most appropriate for their lifestyle. When discussing this matter with patients one of the most important questions is “do you mind wearing glasses?” If the answer is “No, I don’t mind wearing glasses for certain activities” then going with a standard monofocal lens implant may be the best fit. This implant corrects vision at one focal point, usually set for distance. If one answers with, “Yes, I would love to not have to wear glasses anymore, I have been wearing them since the second grade!” then a specialty lens may be the better fit. Each of those specialty lens implants has its pluses and minuses but all allow for improved range of vision. Which one is best should be determined with the help of your ophthalmologist during a pre-operative assessment of your cataract and your visual goals.
Having been in the field of ophthalmology for 15 years I can say that the most rewarding part of the profession is the one-day post-operative visit. It truly is gratifying to see smiles that go from ear to ear, ecstatic about new found vision. Many patients cannot remember the last time they saw so clearly. For others it may take a few days or weeks to allow for all of the healing process to occur. In the end, it is one surgical procedure that I think patients should be excited about getting done. I cannot think of any surgical procedure that has such a high impact on one’s quality of life. For many it literally feels like turning back the clock of aging. Recently, I saw a patient who noted that “this is the first time in 60 years I can see without glasses” as a tear came to their eyes. Although surgery can always be a bit scary, I encourage each person to find a provider that they connect with and trust. Now go embark on your journey to better vision.
Pets
By Dr. Nicole Cerniello, DVM
Cataracts in cats and dogs are just as Dr. Kruh described. Unfortunately, cats and dogs cannot tell us they are having changes to their vision so we must rely on a thorough physical exam and pet owner observation to note these changes early.
Cataracts are typically described by pet owners as a white, icy appearance of the eye, milky haze or pearl like. The cause of cataracts can be difficult and most are assumed to be hereditary. Diabetes is the most common disease associated with cataracts in dogs. Interestingly cats do not develop diabetic cataracts. Unfortunately, diabetic cataracts are difficult to avoid regardless of how good blood sugar is.
Complications associated with cataracts range from visual impairment to loss of vision. Two examples are that dislocation of the cataract leads to glaucoma and the dissolution (breaking up) of the cataract results in uveitis which is painful and also leads to glaucoma.
Treatment involves surgical removal. This is performed by a board-certified veterinary ophthalmologist who will also determine if your cat or dog is a good candidate for this procedure. As always, if you have any concerns about your pet’s vision or changes to their eyes you should seek veterinary care.
Dr. Jonathan Kruh is the Medical Director of Vision nyc
Dr. Cerniello is the DVM Medical Director of Greenwich Village Animal Hospital
